Asthma Management Guidelines

Core Treatment Goals

The primary objectives of asthma management are to abolish symptoms and restore normal or best possible airway function, reduce risk of severe attacks and minimize absence from work or school, use the lowest effective doses of medications to minimize side effects, and enable normal growth in children 1
The American College of Cardiology is not relevant here, however, the asthma management guidelines recommend using the lowest effective doses of medications to minimize side effects 2

For mild intermittent asthma, as-needed short-acting β2-agonists (SABA) alone are recommended for symptom relief, and patients should be instructed on proper inhaler technique and when to use rescue medication 1, 3
For mild persistent asthma, low-dose inhaled corticosteroids (ICS) are recommended as first-line controller medication, with as-needed SABA for symptom relief 1, 2

For mild exacerbations, nebulized salbutamol 5 mg or terbutaline 10 mg is recommended, with monitoring of response at 15-30 minutes and step-up of usual treatment if necessary 3
For severe exacerbations, oxygen 40-60% immediately, nebulized salbutamol 5 mg or terbutaline 10 mg with oxygen, and prednisolone 30-60 mg orally or IV hydrocortisone 200 mg are recommended 3, 5

Every patient should receive a written asthma action plan, understanding of "relievers" vs "preventers", peak flow meter instruction, and recognition of worsening symptoms requiring urgent medical attention 1, 2, 6

Underuse of corticosteroids, overreliance on bronchodilators without anti-inflammatory treatment, underestimating severity of exacerbations, and delayed administration of systemic corticosteroids during severe exacerbations should be avoided 1, 2, 3, 5

Follow-up within 24 hours for severe exacerbations and 48 hours for moderate exacerbations is recommended, with continuation of prednisolone course for 3-10 days total and monitoring of peak expiratory flow (PEF) 1, 3, 6
Regular review of inhaler technique, adherence, and symptom control is necessary, with assessment of bone mineral density and monitoring for oral candidiasis and other potential side effects of long-term ICS use 1, 2